War, Migration and Child Survival in Angola

This purpose of this study is to examine the effects of migration induced by war (war migration) and that motivated by other reasons besides war (non-war migration) on child mortality and utilization of prenatal and delivery care in Angola, a sub-Saharan African country that has been trapped in recurrent episodes of devastating civil war over prolonged and intermittent periods during the last three decades. Two main questions are explored: whether child survival and maternal health care utilization are affected by the fact and circumstances of migration and whether there are longer-term effects of war-related migration on child survival and utilization of maternal health care services in the place of migration destination. Data are drawn from a 2004 cross-sectional representative survey of two peri-urban municipalities in greater Luanda. The survey instrument gathered detailed data on birth histories, prenatal consultations, place of delivery and the immunization status of children nine months and above. Respondents who migrated were also asked to give the localities of their previous residence, the timing of migration and the reasons why they migrated from their previous locality. These responses were classified by interviewers into six categories (war-related, economic, family, education, health or other) and are relied on to construct key outcomes and predictors of the study. Discrete-time event-history techniques are used to analyze the effect of migration status on child mortality and simple logistic regression models are used to examine effects of migration on maternal health care utilization. Results show that in the short term, war migration is associated with lower probabilities of child survival and lower use of maternal health services compared to non-war migration. In the longer-term, the effects of migration circumstances on child survival were negative but not significant, while those on maternal care utilization remained negative and significant. Compared to long time residents of Luanda and non-war migrants, war migrants were less likely to use prenatal and delivery care services. Post-war reproductive health policies may be shaped by making distinctions between economic and forced migration when it comes to maternal and child health since the mechanisms of these migration processes are not only different but are on the ascendancy throughout conflict regions.